Access to health care for drug users as an effective tool for HIV control in Uzbekistan Azizbek A. Boltaev, M.D. Licit and Illicit Drugs Seminar Supported by OSI IPF-Budapest, Award B9163 &amp; IHRA Injecting Drug Use and HIV in Uzbekistan

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mistrust of drug users to Trust points and narcology service regarding their collaboration with militia (police)

inadequate or sometimes no provision with clean injecting equipment

absence of outreach work among IDUs;

absence of system of rewards or incentives for Trust points employees: very often doctors responsible for Trust points are not paid at all for this job and they try to transfer this job to another doctor.

sometimes employees of Trust points do not understand their mission, and some of them think that their primary responsibility is to register as many IDUs as possible and control their behavior:

One of key informants has recollected a case when one of new doctors of city-based Trust points as evidence of his excellent activity brought tens of letters signed by IDUs promising not to share their injecting equipment with peers!

NGOs, successfully accessing IDUs and offering SEP, were indicated as not sustainable institutions and totally dependent on financial support of international donors.

The longer drug use history the lesser care of their own health among drug users and health care seeking

Detox in official state owned clinics was indicated as highly inaccessible due to shortage of beds in hospitals and very undesirabledue to fear of being registered and as a result to get into the “black list” of police.

High threshold services limits utilization of the services by drug users

Often those who came to narcology dispensary to enter into treatment program are being refused due to that more than ¾ of beds in clinics are being occupied by those who are on compulsory treatment which may continue 3-6 months.

Police direct their efforts on seizure of drug users as crimes rather than drug dealers

Key informants know about lots of examples drug users were imprisoned by requests of relatives after several unsuccessful attempts to get off the needle with support of doctors or having difficulties to access a good addiction treatment. Informants believe that there are lots of IDUs are put into jails under mentioned circumstances.

Introduction of methadone in Uzbekistan depends on personal opinion and believes of officials from state drug control agencies.

General Practitioners lack of knowledge and skills to effectively work with patients who use drugs. Hence, very often doctors do not ask questions related to possible drug use history of the patient

Services for drug users provided by NGOs are concentrated mostly in Tashkent, the capital of Uzbekistan while very modest number or none of IDUs from cities and rural areas outside of the capital have access to such kind of services.

Different health services such as narcology, AIDS, SEPs, intensive care, Infection clinics, psychiatric hospitals are not integrated in HIV prevention efforts and in improving access to health care for IDUs and often don’t know about the services offered by partners

“Total abstinence from drug use or nothing” approach is dominated in drug treatment service

Services offered to drug users are designed without respect of their stage of change (Prochaska & De Clemente) and targeted only oh those who are in Determination\Preparation and Action stages.

In general there are no relapse prevention program is offered in Uzbekistan

Uzbekistan has established a countrywide network of trust points (n=230) administered by AIDS Center to deliver harm reduction services as syringe exchange and condom distribution for IDUs and SWs (cover about 1% of estimated # of IDUs

Swiss Government finances two syringe/ needle exchange programs in Samarqand and Tashkent operated by local NGOs

Governmental Narcology Dispensaries have about 1600 beds to provide treatment of substance use disorders which mostly consists of detox with partial rehabilitation program which is ~60 times lower comparing to the # of estimated drug users needed treatment

Global Fund against AIDS, TB, and Malaria supported Uzbekistan’s grant proposal on “Scaling-Up the Response to HIV/AIDS and Tuberculosis in Uzbekistan: A Focus on Vulnerable Populations” with a over 25 million budget for the period of 2004-2007

Two AA and AN self support groups operate in Tashkent and one in Angren.